Varicose veins are those bluish-purple lumpy marks on the legs of more than half of us. Not only are they unsightly, but can also be the cause of the heavy aching discomfort you get when you stand for any length of time, they can itch and throb and cause cramps at night. Occasionally they also lead to more serious medical problems including leg ulcers and hard brown skin at the ankle, and blood clots.

There are different types of veins. Most people, in particular ladies, have fine “thread” or capillary veins, its just the amount that varies. These don’t stand out, but look like a matting or purple pen marks. Although unsightly in the summer these are rarely associated with other medical problems. Several people have varicose veins which protrud out when they stand up. These are “trunk” veins and affect both ladies and men andcan lead to the other symptoms.

As there are new treatments coming on line all the time, if you have any worries that you may have varicose veins or their complications, you really should see an expert vascular surgeon.

When you do, the doctor will take a history and examine your legs. Usually an ultrasound scan of the veins is performed to highlight the underlying vein problem. Occasionally if the veins are suspected to be coming from the pelvis, which can happen after pregnancies, an MRI is undertaken. Based on this the best treatment for you and your legs will be discussed with you before any intervention is decided.

For the thread veins it is usually possible to undergo “microsclerotherapy”. This is when a small amount of solution is injected into the vein through a fine needle in the consulting rooms to clear the vein. Over the next few weeks the body then absorbs the vein leaving the leg clear of marks. Often more than one course of injections are needed and people come back intermittently for “top up” treatments. If the veins are really fine a skin laser machine is used to clear them.

It is now rare for “trunk” varicose veins to be “stripped” out and the usual treatment is to pass a wire up the defective vein and heat the vein so it shrivels up. The heat is generated by a laser or high radiofrequency. At the same time the lumpy veins are removed via a small incision over them. The procedure is usually under local anaesthetic, sometimes with sedation, but rarely a full general anaesthetic. It is very much a day case procedure and you will usually be back to normal within a couple of days.

Sometimes it is necessary to use other techniques, especially if the surgery is for recurrent varicose veins. This includes injecting a foam of glue (sclerosant) into the veins. If varicose veins are involving the pelvis veins and the symptoms are appropriate occasionally it is necessary to block off the non functioning veins in the pelvis as well. This is undertaken while you are awake in a special vascular theatre when a small catheter is placed from the neck and a fine “coil” of wires placed into the non functioning pelvic vein.

If the veins are associated with skin thickening, brown staining or leg ulcers at the ankle it is common to manage this by wearing support stockings as well as surgery. The stockings can also be used if you don’t want surgery for your aching veins or when you are travelling on a long haul flight. It is best to wear the ones that come up to the knee, they come in lots of different colours, sizes and strengths, so you can pick the one you want and if you wear them for any length of time they need to be replaced regularly.

Often people have concerns that the veins will come back. To minimise this it is important that you and your specialist work out exactly what symptoms you have and assess the likelihood of success of treatment. Sometimes you may opt just to wear stockings for a short period, but the newer surgical techniques are very good and your surgeon will advice you.

Make sure the expert you see undertakes all procedures so you get the treatment suitable to you and not just what they have available.

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